Background: Patients who are admitted during off-hours (nights and weekends) are thought to have worse outcomes. This might be explained by delayed times to treatment. We sought to determine the effect of off-hour presentation on processes of care and outcomes at a comprehensive stroke center.
Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution between Sep 2010-Dec 2016. All patients that underwent endovascular therapy for large vessel occlusion acute ischemic stroke were included and categorized into two groups: those arriving during regular hours (weekday 7AM-7PM) or off-hours. The 2 groups were then matched for age, baseline NIHSS and glucose levels using a weighted Euclidian distance method. Baseline, procedural, and radiological characteristics, as well as outcome parameters were compared.
Results: 926 (463 pairs) patients were included. Patients presenting off-hours had higher rates of hypertension (78.2% vs 66.7%, p<0.01) and longer median time from last-known normal to picture (273 minutes [167-421] vs 253[145-472], p=0.04). Other baseline characteristics including comorbidities, NIHSS, ASPECT scores, occlusion site were well balanced. There was no difference between groups in picture to puncture median time (57 minutes [38-95] vs 52[36-78], p=0.11) and utilization of CT angiography (p=0.56) or CT perfusion (p=0.82) imaging or IV t-PA use (p= 0.37). Moreover there were no differences between groups in terms of rates of successful reperfusion (mTici 2b-3) (p=0.26), parenchymal hematomas (p=0.12), 90-day good outcomes (mRS 0-2) (p=0.99) or mortality (p=0.52). In multivariate analysis, off-hour presentation was not associated with 90-day good outcome.
Conclusions: Our study shows that patients presenting off-hours have similar picture to puncture times and clinical outcomes as those presenting during regular hours.